The Treatment of Infected Pacemaker and Defibrillator Wounds with Nitric Oxide / Plasma Energy

The incidence of postoperative surgical site infections continues to be a significant problem especially when surgical foreign bodies are implanted into the tissues such as cardiovascular implants including pacemakers and defibrillators.  The incidence of infection can range from 13% to as high as 80% and continues to rise at an alarming rate. (1,2,3).  Treatment of these infections requires removal of the implanted device, debridement of the wound to remove any necrotic and infected tissue, and treatment with appropriate antibiotics.  In the case of cardiac pacemakes and defibrillators, the device must be placed in another location while the infected site is being treated significantly adding to the hospital stay, morbidity, and treatment cost. The use of gaseous nitric oxide has been found to be beneficial in treating these problems without opening operative wounds or removing implanted devices.  The nitric oxide is generated from the surrounding air and the nitric oxide molecules are attached to a plasma energy stream stabilizing the molecule so that it can be delivered to the tisues with good therapeutic effect.  This ntiric oxide / plasma energy stream will penetrate intact skin up to 3 cm deep allowing treatment of infections without opening the skin.  During the treament, no part of the device touches the patient so there is no need for disposable parts or sterilization of the device.  Nitric oxide is effective against bacteria, fungus, and viruses with no organisms known to be resistant to its effects. (4,5)  The treatment is painless, and no adverse reactions have been encountered.  We have treated a series of 5 patients with infected and disrupted pacemaker and defibrillator wounds with the nitric oxide / plasma energy without opening the operative wound or removing the device.  Each patient was treated with the nitric oxide / plasma energy once per week for an average of 7 minutes per treatment.  All patients healed with an average of 4 treatments (range of 2 to 7 treatments).  No patient has had a recurrent wound or infection problem with a minimum follow-up of 2 years.  Further details of the treatment will be presented.